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Catheter ablation in AF patients improves left ventricular systolic dysfunction

Catheter ablation of atrial fibrillation (AFCA) efficacy in patients with impaired left ventricular systolic function improves when performed early in the natural history of atrial fibrillation (AF) and heart failure, according to a study published recently in Circulation: Arrhythmia and Electrophysiology.1 AFCA provides long-term benefits on left ventricular function, significantly reducing the number of patients with severely impaired systolic function, the authors add.

A systematic review was conducted in MEDLINE/PubMed and Cochrane Library. Randomised controlled trials, clinical trials and observational studies including patients with left ventricular systolic dysfunction undergoing AFCA were included. 26 studies were selected, including 1,838 patients. Mean follow-up was 23 (95% Confidence Interval: 18-40) months. Overall complication rate was 4.2 (3.6–4.8)%. Efficacy in maintaining sinus rhythm at follow-up end was 60 (54–67)%.

Meta-regression analysis revealed that time since first AF (p=0.030) and heart failure (p=0.045) diagnosis related to higher incidence of AF recurrences, while absence of known structural heart disease (p=0.003) to lower incidence. Left ventricular ejection fraction improved significantly during follow-up by 13% (p<0.001), with a significant reduction of patients presenting an ejection fraction <35% (p<0.001). NT-proBNP blood levels decreased by 620 pg/ml (p<0.001).

AFCA is an established therapeutic option for rhythm control in symptomatic patients. Its efficacy and safety among patients with left ventricular systolic dysfunction is based on small populations, and data concerning long-term outcome are limited. The authors performed this meta-analysis to assess safety and long-term outcome of AFCA in patients with left ventricular systolic dysfunction, to evaluate predictors of recurrence and impact on left ventricular function.

References

1. Anselmino M, Matta M, D’Ascenzo F, et al. Catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol 2014. http://dx.doi.org/10.1161/CIRCEP.114.001938

Published on: October 31, 2014

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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